Short Supplies and Effects of ‘Worried Well’ Complicate NJ’s Planning for COVID-19 Surge

To deal with expected influx of patients, measures could include drafting in retired health care professional and reopening facilities that had been closed
State epidemiologist Dr. Christina Tan, left, and Health Commissioner Judith Persichilli at a Friday briefing on the state’s COVID-19 response

With the growing impact of COVID-19, New Jersey health officials are reviewing plans for a likely hospital surge that could include reopening acute care facilities that had been closed in recent years, scaling up services at smaller community hospitals and calling in retired health care professionals to tend to the anticipated influx of patients.

Hospital executives are also making operational changes to prepare for more cases of the illness caused by the new coronavirus. By Sunday, 98 New Jerseyans had tested positive and two had died. Some facilities have already rescheduled elective surgeries and routine appointments, while others may suspend clinic services and community health programs.

“A surge in hospital use is what we’d be most concerned about,” state Department of Health Commissioner Judith Persichilli said last week at one of the daily briefings New Jersey officials have held since the first cases were diagnosed here ten days ago. Significant worries involve physical space and staffing levels, she said, and in particular the limited availability of certain medical supplies, like protective masks and gowns.

“The hospitals are on the front lines,” Pershichilli added. “They are treating patients who have tested positive, while at the same time dealing with community concerns.” Reducing the pressure on these facilities is important to avoid “overstressing” the state’s hospitals, she said, a scenario that emerged in Italy and has reportedly led medical providers there to ration care and prioritize younger patients over older, sicker individuals.

New Jersey leaders are already collecting additional medical supplies from federal and state stockpiles, including certain masks and face shields, protective gowns and other items now in short supply at some hospitals. Distribution of these materials will begin soon, but some labor leaders have warned that hospitals have been slow to train frontline workers on how to properly use this equipment.

Equipment and training

“There are shortages all over,” said Debbie White, a nurse who is president of the Health Professionals and Allied Employees union, which represents thousands of frontline health care workers. She and other union leaders started sounding the alarm last week.

“Our biggest focus is getting equipment to our members, getting training to our members,” she said, including when to use the gear and how to safely put it on and take it off. “I don’t want to terrify people, but this is a serious, serious thing.”

Concerns are growing nationwide about the toll the coronavirus will take on our health care system, in particular hospitals and their staff, who can come into daily contact with the virus. Public health experts agree COVID-19 cases will continue to rise — more than 3,000 people nationwide have already been infected, resulting in at least 62 deaths — as, they say, will the number of frontline workers that get sick and are forced to stop working. While the novel coronavirus results in mild, cold-like symptoms in most people, it can be fatal for older individuals and those with compromised immune systems.

New Jersey officials said the positive tests now include a worker at Newark’s University Hospital, the state’s only public hospital, which is also treating 11 patient cases. Several employees at Hackensack Meridian Health Bayshore Medical Center were tested for COVID-19 and results came back negative, the hospital said. As a result, the Monmouth County facility had been diverting new emergency-room patients to other area hospitals for treatment. On Monday, the hospital said the emergency room is again open.

Given these concerns, public health leaders are frustrated by the rising tide of what they call the “worried well” — people with minor symptoms flooding clinics and emergency rooms seeking coronavirus testing. They urge otherwise healthy people to stay home, avoid close contact with friends and family, and take over-the-counter medicines as needed.

What to do if symptoms worsen

If symptoms escalate, or if you have an underlying medical condition, experts recommend you call your doctor or the state hotline before going to the hospital. The goal is to preserve hospital resources — from staff time to gowns — for those who need it most, including victims of heart attack, stroke or other critical conditions unrelated to coronavirus.

“Having the right care in the right setting — which could include not going to a healthcare facility — will help to protect yourself, other patients, and healthcare providers,” said Dr. Manish Trivedi, the director of infectious diseases at AtlantiCare, which operates several hospitals in South Jersey. “Taking this precaution and following all precautions for preventing the spread of coronavirus and other illnesses will also ensure healthcare workers are available to provide timely, direct care for ill patients.”

Given the limited number of testing kits currently available, AtlantiCare and other providers have followed strict federal protocols on which patients can be tested. The state DOH lab and two private facilities can now process these samples, but several health care networks in New Jersey are also working rapidly to create their own testing. Gov. Phil Murphy has said the state is examining other options and widespread testing should be available later this week.

But as testing expands — and the virus continues to infect more New Jerseyans — health care officials are bracing for even more traffic at the state’s 72 acute care hospitals. These facilities already care for some 15 million patients annually, including 3.8 million in the state’s emergency rooms, according to the New Jersey Hospital Association, which has called for outside visits to health care facilities to be suspended, with limited exceptions in maternity wards, with hospice patients and in a handful of other scenarios, to help protect patients and staff from the virus and other infections.

Officials at DOH, which licenses hospitals, said Garden State hospitals have close to 23,700 beds, including nearly 2,000 with staff and equipment required to care for adults with intensive care needs. Another 1,600-plus beds are licensed for post-surgical use, which officials said can be stepped up to ICU service if needed. There are also some 700 isolation rooms, which are optimal for patient quarantine.

Will there be enough beds?

“The most concerning resource I’m seeing is space. Not just isolation rooms, but beds all over,” said Dr. Shereef Elnahal, president and CEO of University Hospital and the former state health commissioner; he is also keeping a close watch on the hospital’s stocks of protective gear and dwindling supplies of hand sanitizer. “At University, we’re at capacity almost all of the time,” Elnahal added, and the emergency room is “very crowded at baseline” without any COVID-19 cases.

The DOH has sought to get ahead of any shortage of beds for COVID-19 patients by preparing waivers that will allow hospitals to start using beds and rooms that have been taken out of service as capacity declined in the past or licensing requirements changed. On Sunday, Persichilli said the department is also working with the hospital association on potential plans to reopen recently shuttered facilities or create partnerships between larger university systems and community hospitals that will enable the smaller sites to treat more complex cases.

Staffing is another persistent worry for public health leaders, especially given the existing shortage of certain medical providers — like primary care doctors and nurses — in some parts of the state. To help fill the gap, DOH officials said they could consider activating the state’s Medical Reserve Corps — a group of 5,000 health care professionals and community volunteers — as well as calling in retired doctors and nurses, reassigning staff from administrative to bedside duties, or hiring temporary health care workers.

Fears of supply shortages have sparked concern in New Jersey and nationwide, with much of the attention focused on the N95 masks used by health care professionals to protect against coronavirus contamination. Some facilities have kept these masks and other protection gear locked up, HPAE’s White said. And hospital officials concede they are making tentative plans for shortages, including discussing how some items could even be safely reused.

“We’re fine today, but we’re watching our supplies on a daily basis,” Dr. Adam Jarrett, executive vice president and chief medical officer at Holy Name Medical Center in Teaneck,  said last week. “And we do have concerns if the pace escalates and we don’t get adequate stocks (of masks and other items) back on our shelves.”

Murphy: NJ ‘got a fraction’ of requested federal supplies

Jarrett said additional supplies from the federal stockpile were critical, especially for hospitals  in hard-hit areas like Bergen County, which has seen the bulk of the state’s cases so far. “We’re seeing an almost doubling of patients every day,” he said.

Luckily, the state has now received four truckloads of stock from a national emergency stockpile, DOH said Saturday. This includes 13,000 gloves, 4,500 masks, more than 2,000 face shields and nearly 1,500 gowns or coveralls, according to the department. (Gov. Phil Murphy said Friday this would also include tens of thousands of N95 masks, although it was not clear if they have already arrived.)

Either way, Murphy — who declared a state of emergency last week and expects to close schools statewide today — has stressed that more supplies are still needed. “We got a fraction of our ask” to the federal government, he said Sunday, “and we’re burning through that fairly quickly.”

Persichilli has also met with HPAE and other health care unions to discuss supplies, training and other issues, including staffing needs. “Our health care unions are rightfully concerned about the protection of health care workers throughout our state as they care for patients. We need them to stop the virus,” she said Saturday.

“The protection of health care workers is so important, because if they have to go into quarantine it isn’t going to be one or two (workers), it will be a unit of 14 (employees), and that’s a problem,” Persichilli noted last week, using that number as an example of the widespread impact it could have on some hospitals.

< Editor’s note: This story has been updated to correct previous information provided at yesterday’s state briefing on the outbreak that indicated employees at Hackensack Meridian Health Bayshore Medical Center had been diagnosed with COVID-19. The hospital reports that all tests of its employees came back negative. >